Prehabilitation before general surgery: Worth the effort?

Prehabilitation, or interventions before surgery aimed at improving preoperative health and postoperative outcomes, has various forms. Although it may confer benefit to patients undergoing general surgery, this is not certain. Furthermore, although it may yield a net monetary gain, it is also likely to require substantial monetary and non-monetary investment. The impact of prehabilitation is highly variable and dependent on multiple factors. Physical function and pulmonary outcomes are likely to be improved by most forms of prehabilitation involving physical and multimodal exercise programmes. However, other surgical outcomes have demonstrated mixed results from prehabilitation. Within this issue, the measures used for evaluating baseline patient biopsychosocial health are important, and collecting sufficient data to accurately inform patient-centred prehabilitation programmes is only possible through thorough clinical and laboratory investigation and synthesised metrics such as cardiopulmonary exercise testing. Although a multimodal approach to prehabilitation is the current gold standard, societal factors may affect engagement with programmes that require a significant in-person activity. However, this is weighed against the substantial financial and non-financial investment that accompanies many programmes. The overall effectiveness and optimal mode of intervention across the discipline of general surgery remains unclear, and further research is needed to prove prehabilitation's full worth.

Survival in Patients With Suspected Myocardial Infarction With Nonobstructive Coronary Arteries: A Comprehensive Systematic Review and Meta-Analysis From the MINOCA Global Collaboration.

BACKGROUND: Suspected myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) occurs in ≈5% to 10% of patients with MI referred for coronary angiography. The prognosis of these patients may differ to those with MI and obstructive coronary artery disease (MI-CAD) and those without a MI (patients without known history of MI [No-MI]). The primary objective of this study is to evaluate the 12-month all-cause mortality of patients with MINOCA. METHODS: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the terms "MI," "nonobstructive," "angiography," and "prognosis" were searched in PubMed and Embase databases from inception to December 2018, including original, English language MINOCA studies with >100 consecutive patients. Publications with a heterogeneous cohort, unreported coronary stenosis, or exclusively focusing on MINOCA-mimicking conditions, were excluded. Unpublished data were obtained from the MINOCA Global Collaboration. Data were pooled and analyzed using Paule-Mandel, Hartung, Knapp, Sidik & Jonkman, or restricted maximum-likelihood random-effects meta-analysis methodology. Heterogeneity was assessed using Cochran's Q and I2 statistics. The primary outcome was 12-month all-cause mortality in patients with MINOCA, with secondary comparisons to MI-CAD and No-MI. RESULTS: The 23 eligible studies yielded 55 369 suspected MINOCA, 485 382 MI-CAD, and 33 074 No-MI. Pooled meta-analysis of 14 MINOCA studies accounting for 30 733 patients revealed an unadjusted 12-month all-cause mortality rate of 3.4% (95% CI, 2.6%-4.2%) and reinfarction (n=27 605; 10 studies) in 2.6% (95% CI, 1.7%-3.5%). MINOCA had a lower 12-month all-cause mortality than those with MI-CAD (3.3% [95% CI, 2.5%-4.1%] versus 5.6% [95% CI, 4.1%-7.0%]; odds ratio, 0.60 [95% CI, 0.52-0.70], P<0.001). In contrast, there was a statistically nonsignificant trend towards increased 12-month all-cause mortality in patients with MINOCA (2.6% [95% CI, 0%-5.9%]) compared with No-MI (0.7% [95% CI, 0.1%-1.3%]; odds ratio, 3.71 [95% CI, 0.58-23.61], P=0.09). CONCLUSIONS: In the largest contemporary MINOCA meta-analysis to date, patients with suspected MINOCA had a favorable prognosis compared with MI-CAD, but statistically nonsignificant trend toward worse outcomes compared to those with No-MI. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42020145356.

Photoconductive mechanism of IR-sensitive iodized PbSe thin films via strong hole-phonon interaction and minority carrier diffusion.

Photoconductive PbSe thin films are highly important for mid-infrared imaging applications. However, the photoconductive mechanism is not well understood so far. Here we provide additional insight on the photoconductivity mechanism using transmission electron microscopy, x-ray photoelectron microscopy, and electrical characterizations. Polycrystalline PbSe thin films were deposited by a chemical bath deposition method. Potassium iodide (KI) was added during the deposition process to improve the photoresponse. Oxidation and iodization were performed to sensitize the thin films. The temperature-dependence Hall effect results show that a strong hole-phonon interaction occurs in oxidized PbSe with KI. It indicates that about half the holes are trapped by KI-induced self-trapped hole centers (Vk center), which results in increasing dark resistance. The photo Hall effect results show that the hole concentration increases significantly under light exposure in sensitized PbSe, which indicates the photogenerated electrons are compensated by trapped holes. The presence of KI in the PbSe grains was confirmed by I 3d5/2 core-level x-ray photoelectron spectra. The energy dispersive x-ray spectra obtained in the scanning transmission electron microscope show the incorporation of iodine during the iodization process on the top of PbSe grains, which can create an iodine-incorporated PbSe outer shell. The iodine-incorporated PbSe releases electrons to recombine with holes in the PbSe layer so that the resistance of sensitized PbSe is about 800 times higher than that of PbSe without the iodine-incorporated layer. In addition, oxygen found in the outer shell of PbSe can act as an electron trap. Therefore, the photoresponse of sensitized PbSe is from the difference between the high dark resistance (by KI addition and iodine incorporation) and the low resistance after IR exposure due to electron compensation (by electron traps at grain boundary and electron-hole recombination in KI hole traps).

Thermal Stability of Titanium Contacts to MoS2.

Thermal annealing of Ti contacts is commonly implemented in the fabrication of MoS2 devices; however, its effects on interface chemistry have not been previously reported in the literature. In this work, the thermal stability of titanium contacts deposited on geological bulk single crystals of MoS2 in ultrahigh vacuum (UHV) is investigated with X-ray photoelectron spectroscopy and scanning transmission electron microscopy (STEM). In the as-deposited condition, the reaction of Ti with MoS2 is observed resulting in a diffuse interface between the two materials that comprises metallic molybdenum and titanium sulfide compounds. Annealing Ti/MoS2 sequentially at 100, 300, and 600 °C for 30 min in UHV results in a gradual increase in the reaction products as measured by XPS. Accordingly, STEM reveals the formation of a new ordered phase and a Mo-rich layer at the interface following heating. Due to the high degree of reactivity, the Ti/MoS2 interface is not thermally stable even at a transistor operating temperature of 100 °C, while post-deposition annealing further enhances the interfacial reactions. These findings have important consequences for electrical transport properties, highlighting the importance of interface chemistry in the metal contact design and fabrication.

The relationship of trauma exposure to sex offending behavior among male juvenile offenders.

The most common type of adult and juvenile sex offender treatment utilizes a Relapse Prevention (RP) model. In RP clients learn about their offense cycle with an emphasis on recognizing high-risk situations and negative emotional states that can be precursors or triggers to offending behavior. This study identifies ways that traumatic experiences and trauma-associated feelings can be offense triggers for juvenile sex offenders. Researchers interviewed the treating clinicians of 40 male juvenile sex offenders who received at least six months of RP sex offender treatment. Results showed that 95% of the youths had experienced a Post Traumatic Stress Disorder (PTSD) Criterion A traumatic event and that 65% met criteria for PTSD based on clinician judgments. Overall, clinicians identified prior trauma exposure as being related to the offense triggers in 85% of offenders. Specifically, the following trauma-related feelings were identified as offense triggers: intense fear in 37.5% of sex offenders, helplessness in 55%, and horror in 20%. Implications for sex offender treatment programs are discussed.